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Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What do these MRI findings indicate?

Answered by
Dr.
Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6535 Questions

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Posted on Tue, 12 Jun 2018 in X-ray, Lab tests and Scans
Question: Attached are MRI images I took today ago for abdominal pain that I've had for a month now. Please review and provide me your interpretation of the MRI
doctor
Answered by Dr. Vivek Chail 58 minutes later
Brief Answer:
Please send more images for a detailed interpretation

Detailed Answer:
Hi,
Thanks for writing in.

Your liver, kidneys, spleen and the visualised bowel look fine.

But I would like to have a detailed look at the gall bladder and pancreas which is now well visualised in the images which you have sent.

The images which you have uploaded gives limited information on the structures in the abdomen.

A typical MRI scan abdomen consists of multiplanar imaging planes and multiple sequences in each plane to see particular organs.

The images sent by you are in the coronal plane and of T2 sequence.

There is no significantly abnormal finding in the images but I would like to see through the rest of the images of your MRI scan to give a detailed interpretation.

Please send and any ultrasound report which was done before the scan.

MRI scan of the abdomen usually requires comparison with previous studies like ultrasound scan or CT scan to get a better insight of any suspected abnormality.

Regards,
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Vivek Chail 1 hour later
Dr. Chail,
thank you for your reply. This website only allows me to upload 11 images per question. Therefore, I had to create 7 questions so I can upload 69 images. Would you please go through all 7 questions to see all 69 images? Another option is I can email you the images if needed.


Here are the links to the questions containing all MRI images:

http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=357997

http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=357998

http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=358000
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=358001
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=358004
doctor
Answered by Dr. Vivek Chail 10 hours later
Brief Answer:
Please email your images to the given address

Detailed Answer:
Hi,
Thanks for writing back with an update.

The links to the questions are not functional. Please email me your emails to YYYY@YYYY and write a follow up question. This is my own email and is shared at your request only for sending of images.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 46 minutes later
I just emailed you all 69 images from the MRI CD. Please let me know if you received them alright. I also uploaded them to google drive and shared them with you.
doctor
Answered by Dr. Vivek Chail 13 hours later
Brief Answer:
There is no serious concern in the images sent

Detailed Answer:
Hi,
Thanks for writing back with an update.

There is no obvious abnormality in the images which you have sent.

As a doctor, I would like to know the details of your pain in the abdomen, which area is the pain so that I can have a better idea of your problem and review your images again.

Please tell me any relation of the pain with vomiting, food intake, any fever or loose stools and any blood tests done.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 10 hours later
Dr. Chail,
I have upper abdominal pain, mostly in the central, but sometimes the pain is on the left side and some other time on the right. I have severe chills. I had constipation for about 4 weeks but it stopped now. My bowel movement is almost back to normal. My urine is dark. Stool is normal (not loose, yellow-brownish color). At one point, I had lots of gas (as the ultrasound noted) and I could hear "grumbling" noise from my tummy. But gas and grumbling noise have stopped the last 4 days.

I would like you to focus on the pancreas as I am worried about having pancreatic cancer. After the pancreas, please also focus next to the gallbladder.

Pancreas is my most concern. Please focus on that first, then gallbladder

The pain I have is not sharp. It's more than I am feeling my abdominal wants to explode. Do you think I need to have a MRI with contrast because the images I sent you were taken without contrast and it seems like it's not clear enough?
doctor
Answered by Dr. Vivek Chail 19 hours later
Brief Answer:
There is no big lesion involving gall bladder and pancreas

Detailed Answer:
Hi,
Thanks for writing back with an update.

I have reviewed the images and find no significant abnormality in the gall bladder or pancreas area. There is no big mass or lesion. There is no enlargement of the common bile duct.

MRI scan abdomen has got some disadvantages like unclear pictures due to movement. I would have preferred a contrast CT scan abdomen with oral, rectal and IV contrast to have a better view of the abdomen.

If you have pancreas cancer in your family then you can do a CA19-9 marker test in your blood level to know risk for pancreas malignancy. This test is usually done only if there is a lesion in the pancreas.

Regards,
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Vivek Chail 4 hours later
Dr. Chail,
thank you for your review. I had the CA19-9 marker test and the result was normal.

You wrote in your review that "no significant abnormality in the gall bladder or pancreas area. There is no big mass or lesion". Does it mean there were some abnormalities? Since I still have the abdominal discomfort, do I need to follow with another test? I did not want to do CT because of radiation. Do you think I need to have Endoscopic Ultrasound?
doctor
Answered by Dr. Vivek Chail 10 hours later
Brief Answer:
You can get an upper gastrointestinal endoscopy

Detailed Answer:
Hi,
Thanks for writing back with an update.

I meant to comment that I did not find any problem areas when seeing your MRI images. Usually MRI scan is good at picking up any narrowing of the common bile duct. The common bile duct ends in the area of the head of pancreas and therefore any cancer of head of pancreas area usually gives rise to obstruction of the common bile duct.

The MRI test you have taken is a basic MRI of the abdomen and there are special sequences to study the gall bladder area and head of pancreas area in detail and that is called a MRI MRCP. This test is done only when there is a significant suspicion of gall bladder and pancreas lesions.

Since your CA 19-9 is normal therefore I feel your doctor did not recommend a MRCP test.

One of the disadvantages in basic MRI is the image loss due to movement. CT scan does contain a small amount of radiation but can be helpful in studying the abdomen in good detail and is a fast technique.

Endoscopy ultrasound is an advanced imaging which is done when some lesion is found in the basic tests.

Instead you can get an upper gastroduodenoscopy first to rule out any causes in the stomach which might be causing your abdominal discomfort.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 1 hour later


From what I read, there is no good screening tool to screen for pancreatic cancer in people without symptoms. However, in my case, I have symptoms (abdominal pain), what is the probability that the ultrasound and the MRI failed to detect any lesion/mass? I tried to calm myself down realizing that the CA-19-9 blood test, ultrasound and MRI tests are all normal, but still am afraid that they are not accurate enough.

I am just worried that the MRI I took might not be sensitive enough to pick up any tumor/lesion in my pancreas. If my abdominal discomfort is caused by a tumor in in pancreas, would the MRI without contrast I took detect it?

I know you were suggesting the gastroduodencoscopy test but the fear of pancreatic cancer is really frightening me.
doctor
Answered by Dr. Vivek Chail 21 hours later
Brief Answer:
No scan is completely accurate

Detailed Answer:
Hi,
Thanks for writing back with an update.

Sorry for delay in replying.

You are right in saying that there is no single screening test for cancer of pancreas. It is an elusive disease and in most patients, it is diagnosed in advanced stages.

Bigger lesions can be diagnosed in screening tests but tiny ones are most difficult to detect.

However you should not have fear of pancreas cancer because your general health is otherwise good except for the abdomen pain.

You have asked "However, in my case, I have symptoms (abdominal pain), what is the probability that the ultrasound and the MRI failed to detect any lesion/mass? "

You can read through the article at the link below to have a complete view of the latest in detecting cancer of pancreas by various scans.

https://cancerimagingjournal.biomedcentral.com/articles/10.1102/1470-7330.2001.013

It is a research medical literature.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 24 hours later
Thank you Dr. Chail.

I just received my MRI results from my doctor's office. There 2 findings from the report. Would you please review my MRI again to see if you agree with the report, which I just uploaded?

1. Possible sludge in the gallbladder
2. 1 cm cyst of the left kidney, simple in appearance

if you agree with the findings on the report

1. The ultrasound I took before the MRI, which I emailed you, did not show sludge. What can be done to confirm whether I have gallbladder sludge or not?

2. do you recommend me to have another MRI done in a year to make sure the cyst does not grow?

doctor
Answered by Dr. Vivek Chail 25 minutes later
Brief Answer:
Ultrasound scan scan is an acceptable test for cyst and gall bladder sludge

Detailed Answer:
Hi,
Thanks for writing back with an update.

The gall bladder sludge is a doubtful finding because your ultrasound report mentions a clear gall bladder lumen and which is free of stones and sludge. MRI can cause image artefacts which can cast a doubt on what is visualised.

The cyst in left kidney is less than 1 cm and something that can be ignored for now. A cyst smaller than 1 cm is can be followed up after 3 to 6 months on ultrasound. I see such cysts in many patients every day and a tiny single cyst will usually not grow.

Ultrasound scan scan is an acceptable test to look for sludge in gall bladder and the kidney cyst.

For the gall bladder sludge, you can get an ultrasound done on fasting and avoiding taking fatty foods for a day before the scan. This will give a more clear view of the gall bladder lumen.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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